Reducing the number of adult smokers in America may require intervening earlier in life and school than previously thought — probably between the ages of 12 and 17 — according to new research.
The links between educational attainment and smoking are well documented. The more formal schooling individuals have, the less likely they are to be smokers; the less schooling, the more likely.
But a new study by Yale University sociologist Vida Maralani shows that the total number of years in school or advanced degrees earned may not be the most influential factors. That’s because most smokers start smoking before their education is complete.
“Even though we see the largest inequalities in smoking between people who have a college degree and those who don’t, it’s not college that accounts for it,” said Maralani, whose research focuses on the relationships between education and health. “When we see adults smoking, we have to think about their adolescence. Taking up smoking usually happens in the late teenage years — almost no one starts to smoke after age 20. In trying to understand why people with different amounts of education have such different smoking patterns at age 30, it’s important to remember that someone who is a smoker at age 30 has been smoking for a long time.”
In the study, Maralani shows that the large and persistent inequalities in smoking by amount of formal education primarily derive not from educational disparities between smokers and former smokers (quitters), but rather from disparities among people who never take up smoking in the first place (initiation).
That is, the differences in educational attainment among active adult smokers mainly reflect characteristics in the years before smoking began — in most cases, between the ages of 12 and 17.
Most studies of the relationship between education and smoking focus on people who quit smoking, and largely ignore people who never smoke. Maralani’s study suggests that the overwhelming focus on differences in quitting by education is not necessarily the only, or best, perspective for analyzing the problem.
“This work explicitly shows the relative contribution of quitting versus never smoking regularly to educational disparities among current smokers and how this has changed over time in America,” she said. “It shows that we should be trying to figure out why it is that people who go on to get a college degree in their 20s don’t ever start smoking in the first place during their teens. You have to think about education early in life.”
Maralani’s conclusions are based on a massive statistical analysis of data on nearly 600,000 individuals gathered over six decades through federal surveys.
The study, published in the journal Social Science & Medicine earlier this year, is titled “Educational inequalities in smoking: The role of initiation versus quitting.”
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